News - Part 64

The data in Table 1 suggest that most laser bronchoscopy course attendees practice in hospitals that already own or plan to acquire YAG lasers soon after the physician attends such a course. On some occasions, the decision to purchase a laser comes at the behest of a hospital administrator who is interested in maintaining an advantage for high-tech visibility in a competitive marketplace (personal communications from several laser bronchoscopy course attendees). Many times, of course, it is one or a few enthusiastic physicians who persuade their hospital leaders for similar reasons. Read more »

Upon returning to the home practice after attending a laser bronchoscopy course, few physicians have access to animal laboratories to continue practice on such models before beginning to perform laser bronchoscopy in humans. Regardless of whether additional experience with a canine model can be acquired, it is difficult within a local community practice to convince ones colleagues (such as a thoracic surgeon or otorhi-nolaryngologist) to teach and supervise the training of a flexible bronchoscopist with the necessary caseload to become proficient in rigid bronchoscopy. Read more »

Typically, the greatest interest and concern of the course attendees was to practice use of the rigid bronchoscope, as the majority of course attendees did not have prior training or experience with it. Faculty members most often emphasize that a large proportion of laser bronchoscopy should be done through rigid bronchoscopes and with a general anesthetic in humans, although there are reports that local anesthesia and flexible bronchoscopes are acceptable alternatives and may even be preferable for the majority of patients with obstructing bronchogenic carcinomas. Even those practitioners of laser bronchoscopy who take the latter stance state that physicians performing laser bronchoscopy need to have the skills to use the rigid bronchoscope as well. ventolin inhalersRead more »

The importance of avoiding discharge of the YAG laser energy onto the plastic endotracheal tube or inside the flexible bronchoscope was emphasized as a fire hazard. Other safety issues, such as meticulous cleansing of the tip of the quartz fiber and keeping it free from blood or mucus, were also stressed. Opportunities to practice both flexible laser bronchoscopy and rigid laser bronchoscopy, with special emphasis on the latter, would constitute the majority of time in the laboratory. Closed circuit television systems were adapted to the bronchoscope so that the faculty could coach and criticize the course attendee as he or she practiced on the canine model. birth control pillsRead more »

The faculty, in conjunction with vendor representatives, would continue with a demonstration of laser interaction with various materials at which the laser energy could be applied, such as a tongue depressor, fruit, and pieces of meat of different consistencies. Through such demonstrations and subsequent opportunities to fire the lasers at these same objects, the course attendees were taught how to operate the lasers and what to expect with different power settings, duration of laser impulses, and tissues of different colors and composition. Read more »

During the years 1984 to 1986, we offered four courses in laser bronchoscopy at Henry Ford Hospital. Each course lasted 2 to 2^xh days. The didactic material was presented during morning sessions, and consisted of the following topics:
1. Overview of Lasers in Medicine
2. Laser Physics and Tissue Interaction
3. CT Scans and Other Radiographic Techniques in Preoperative Patient Assessment
4. YAG Laser Bronchoscopy
5. C02 Lasers for Larynx, Trachea and Main Bronchi
6. Argon and Tuneable Lasers with the Bronchoscope Read more »

As best possible, the prospective course attendee should determine the content of the course. For laser courses generally (not specific for laser bronchoscopy), the American Society for Laser Medicine and Surgery has proposed a statement regarding Standards of Practice which refers to training:
Hospital privileges are, and must remain, the responsibility of the hospital governing board. Those requesting privileges to use lasers shall meet all the standards of the hospital with regard to board certification, board eligibility, special training, ethical character, good standing, judgment, indications for application, etcetera. In addition, the following laser training and experience is recommended. buy antibiotics online
1. The applicant should review the pertinent literature and audiovisual aids, and should attend laser training courses devoted to teaching of laser principles and safety. These courses should include basic laser physics, laser-tissue interactions, discussion of the clinical specialty field, and hands-on experience with lasers. Such course or courses should like a minimum of 8 to 10 hours. Read more »

Moreover, I would suggest that the complexity of the procedure is considerably greater for laser bronchoscopy than it is for diagnostic or other therapeutic bronchoscopy, so the skills tend to take longer to learn and give rise for greater potential misadventures. What avenues are open to assure the best possible training for all who want or need to acquire this training, and at the same time provide patients with the most competent care we as a profession can deliver? There is the temptation to try to devise a minimum set of initial training recommendations and credentialling requirements to perform these procedures. Read more »

Similar phenomena are taking place now with regard to training in laser bronchoscopy. At present, few physicians have been trained as a natural part of their residency/fellowship programs, so the majority of physicians who wish to become involved in performing laser bronchoscopy must begin by attending a laser bronchoscopy course. Before attending a laser bronchoscopy training course, it is well to consider what the anticipated volume of laser bronchoscopy might be, and how the equipment will be funded and amortized. All laser equipment is expensive, and a system of sharing the equipment with physicians and surgeons in a variety of disciplines is advisable. Estimating laser bronchoscopy volume in a given practice or at one hospital requires knowledge of other qualified or aspiring laser bronchoscopists in ones geographic locale. Read more »

There were several problems in trying to conduct such training. First, practicing pulmonary physicians tend to be a busy lot, and the demands of other patient care issues often made it difficult to come to the teaching hospital on a regularly scheduled basis, even when the teaching institution was located in the same metropolitan area. Second, patients who required bronchoscopy at the teaching institution would be identified in variable numbers for a given day, which made it difficult for the practicing physician to know when adequate caseloads would justify time away from the practice to acquire the desired training and experience. Third, fellows in the training program at the teaching institution greeted such “outsiders” with less than a warm welcome for performing the bronchoscopies under the tutelage of the faculty, as such arrangements would necessarily reduce their caseloads for similar training and experience. Read more »